Management of pregnant women with COVID-19: A tertiary pandemic center experience on 1416 cases.

The aim of this study is to share the comprehensive experience of a tertiary pandemic center on pregnant women with COVID-19 and to compare clinical outcomes between pregnancy trimesters. The present prospective cohort study consisted of pregnant women with COVID-19 who were followed up at Ankara City Hospital between March 11, 2020 and February 20, 2021. Clinical characteristics and perinatal outcomes were compared between the pregnancy trimesters. A total of 1416 pregnant women (1400 singletons and 16 twins) with COVID-19 were evaluated. Twenty-six (1.8%) patients were admitted to the intensive care unit (ICU) and maternal mortality was observed in six (0.4%) cases. Pregnancy complications were present in 227 (16.1%) cases and preterm labor was the most common one (n = 42, 2.9%). There were 311, 433, and 672 patients in the first, second, and third trimesters of pregnancy, respectively. Rates of mild and severe/critic COVID-19 were highest in the first and second trimesters, respectively. The hospitalization rate was highest in the third trimester. Pregnancy complications, maternal mortality, and NICU admission rates were similar between the groups. The course of the disease and obstetric outcomes may be different among pregnancy trimesters. A worse course of the disease may be observed even in pregnant women without any coexisting health problems.

Laparoscopic and imaging findings of growing teratoma syndrome

Growing teratoma syndrome (GTS) occurs during post-treatment observation of ovarian malignant germ cell tumors. The characteristic features of this syndrome are normal tumor marker levels and evident tumoral mass or implants on imaging studies. We report a case of GTS in a 22-year-old woman with a malignant germ cell tumor. After staging surgery and chemotherapy, computed tomography showed peritoneal implants. Laparoscopy was planned to exclude malignant recurrence. During laparoscopy, smooth and pink-colored lesions were seen at the lateral pelvic wall. Histopathologic evaluation reported mature teratoma tissue with extensive mature glial components. GTS is not a malignant condition and the benefit of radical surgical intervention in cases without mass-related complication is not proven. GTS should be kept in mind after primary treatment of ovarian immature teratoma.

Binary grading may be more appropriate for endometrial cancer

Objective: To elucidate the survival consequences of the prognostic factors for endometrial cancer. Material and Methods: This was a retrospective study of 276 patients diagnosed with endometrial cancer who admitted for staging surgery. The extent of the surgery was determined by clinical staging and preoperative evaluation. The pathology specimens were reassessed by a gynecopathologist. Independent risk factors were revealed for the progression-free survival (PFS), overall survival (OS) and disease-specific survival (DSS) utilizing Kaplan-Meier and "Cox" proportional analysis. Results: The median follow up of the patients was 50 months. Of the 29 patients who died, 15 (5.43%) died because of endometrial cancer. Multivariate analysis revealed that independent risk factors for OS and PFS were stage (p=0.002, 0.002, respectively) and grade 3 (G3) histology (p=0.013, 0.015, respectively). Positive peritoneal cytology was an independent risk factor for OS (p=0.024), but not for PFS (p=0.050). Stage (p=0.005) was found to be the only independent risk factor for DSS. Patients with G1 and G2 histology had a similar and more favorable prognosis than patients with G3 histology. Conclusion: Advanced stage, high-grade tumor and the presence of positive peritoneal cytology were ascertained as independent prognostic factors for endometrial cancer. A binary histological grading system could be simpler and as effective as the current three grade system because grade 1 and 2 patients showed similar prognosis.

The rate of SARS-CoV-2 positivity in asymptomatic pregnant women admitted to hospital for delivery: Experience of a pandemic center in Turkey.

OBJECTIVE: To investigate the rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity in asymptomatic pregnant women admitted to hospital for delivery in a Turkish pandemic center. STUDY DESIGN: This prospective cohort study was conducted in Ankara City Hospital between April, 15, 2020 and June, 5, 2020. A total of 206 asymptomatic pregnant women (103 low-risk pregnant women without any defined risk factor and 103 high-risk pregnant women) were screened for SARS-CoV-2 positivity upon admission to hospital for delivery. Detection of SARS-CoV2 in nasopharyngeal and oropharyngeal samples was performed by Real Time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) method targeting RdRp (RNA dependent RNA polymerase) gene. Two groups were compared in terms of demographic features, clinical characteristics and SARS-CoV-2 positivity. RESULTS: Three of the 206 pregnant women participating in the study had positive RT-PCR tests (1.4 %) and all positive cases were in the high-risk pregnancy group. Although, one case in the high-risk pregnancy group had developed symptoms highly suspicious for COVID-19, two repeated RT-PCR tests were negative. SARS-CoV-2 RT-PCR positivity rate was significantly higher in the high-risk pregnancy group (2.9 % vs 0%, p = 0.04). CONCLUSION: Healthcare professionals should be cautious in the labor and delivery of high-risk pregnant women during the pandemic period and universal testing for COVID-19 may be considered in selected populations.

Does different subfertility etiology affect pregnancy rates in intrauterineinsemination cycles?

Background/aim: To investigate the relationship between subfertility etiologies and success rates in controlled ovarian stimulation and intrauterine insemination (COS­IUI) cycles. Materials and methods: The medical records of 218 couples who applied to a university-based fertility center were analyzed retrospectively. Detailed infertility examination data and pregnancy outcomes were compared according to different subfertility etiologies. The study groups with regard to subfertility etiologies were minimal­mild endometriosis, unexplained infertility, and mild male infertility. The primary outcome measure was live birth rate. Results: There were no statistically significant differences between the groups regarding demographics except for total motile sperm count. Live birth rates in the male infertility group were comparable to the endometriosis and unexpected infertility groups (6.6%, 11.9%, and 10.3%, respectively; P = 0.63). Conclusion: The success rate of the mild male subfertility group following COS­IUI cycles for live birth rates was similar to those of the endometriosis and unexplained subfertility groups.

The association of thyroid stimulating hormone levels and intrauterine insemination outcomes of euthyroid unexplained subfertile couples.

OBJECTIVE: To investigate the effect of different TSH (0.5-2.49 mIU/L and 2.5-4.5 mIU/L) levels on intrauterine insemination (IUI) outcomes of euthyroid unexplained subfertile patients who are negative for thyroid antibodies. STUDY DESIGN: In this retrospective cohort study, data of euthyroid subfertile patients who underwent IUI due to unexplained infertility at a university-based infertility clinic between January 2013 and December 2014 were reviewed. A total of 156 patients of them were categorized into two groups according to pre-conceptional TSH levels. The first study group consisted of patients with serum TSH levels 0.5-2.49 mIU/L and the second study group consisted of patients with serum TSH levels 2.5-4.5 mIU/L. The primary outcome measure was live birth rate. RESULTS: Demographics and cycle characteristics of the study groups were similar. There were no statistically significant differences between the study groups regarding main outcome measures (live birth rate, P = 0.82; clinical pregnancy rate, P = 0.64; miscarriage rate, P = 0.57). CONCLUSION: Pre-conceptional TSH levels ranging between 0.5-4.5 mU/L does not appear to have a significant effect on IUI outcome of euthyroid women who are negative for thyroid antibodies.

Vaginal cuff dehiscence following total laparoscopic hysterectomy by monopolar cut vs coagulation mode during colpotomy: A randomized controlled trial.

OBJECTIVES: To assess the effect of monopolar coagulation vs cut mode during colpotomy at total laparoscopic hysterectomy on vaginal cuff dehiscence. STUDY DESIGN: We conducted this randomized controlled trial at a university hospital's department of obstetrics and gynecology from September 2016 through January 2018. Enrolled women were randomized 1:1 to monopolar coagulation or cut modes during colpotomy. We followed up 100 participants in the coagulation arm and 99 in the cut arm for ongoing data collection for 12 weeks after surgery. Exclusion criteria were suspicion of pregnancy, previous radiation therapy, uterine size exceeding 20 weeks' gestation, contraindication for high intraabdominal pressure, clinical advanced stage malignant disease, and conversion to laparotomy before completion of colpotomy. Differences between groups for categorical variables were analyzed by chi-square test and the comparisons of continuous variables between groups were analyzed by Student's t-test RESULTS: The study groups were comparable regarding demographics and perioperative parameters. The rate of vaginal cuff dehiscence in coagulation group (1%) was similar to that of cut group (0%) (p = 0.995). The other vaginal cuff related complication rates were also similar. CONCLUSION: Monopolar coagulation and cut modes during colpotomy at total laparoscopic hysterectomy have similar vaginal cuff dehiscence rates and both energy modes seem acceptable for colpotomy.

Iodine deficiency in pregnant women at first trimester in Ankara

Objective: Iodine deficiency in pregnant woman in Ankara was shown in previous studies. We aimed to conduct a study in a tertiary center to investigate the need for iodine replacement in our population. Material and Methods: This was a single tertiary center, non-interventional, retrospective, cross-sectional study. Data were retrieved retrospectively from 440 women who were in the first trimester in gestational age. Maternal iodine status, thyroid-stimulating hormone (TSH) levels and T4 levels were examined. Urinary iodine concentration (UIC) was calculated based on the Sandell-Kolthoff reaction, which is a colorimetric method. We excluded patients with previous or current thyroid disease. Thyroid hormones and TSH were measured using chemiluminescence immunoassays. Results: Iodine deficiency prevalence (urinary iodine <150 µg/L) was 84.7% in first trimester of pregnancy in our population. The median UIC was 81.6 (1-450) µg/L, indicating iodine insufficiency. All the patients declared iodized salt use. None of the patients were taking iodine replacement. The mean TSH level was 1.53±1.27 mIU/L, (0.01 mIU/L-14.74 mIU/L) and the mean T4 level was 12.51±5.01 mIU/L (7.09 mIU/L-23.7 mIU/L). The TSH levels of 56 patients were higher than 2.5 mIU/L. According to these results, 12.72% of the patients had subclinical hypothyroidism based on serum TSH and free thyroxine levels. Isolated hypothyroxinemia was present in one patient. Conclusion: Our study demonstrated that pregnant women still develop iodine deficiency in Ankara despite mandatory iodine salt use. Iodized salt use does not provide enough iodine supplement, especially in pregnant women. Iodine supplementation has been shown to enhance neurologic development and psychomotor performance. We suggest that iodine should be a part of routine laboratory evaluation at the first prenatal visit for its importance in early pregnancy. Also, iodized salt use education should be provided to women to eradicate iodine deficiency. Iodine supplements should be recommended to all pregnant women in addition to iodized salt.

Sexual dysfunction in patients with systemic sclerosis

Background/aim: The aim of the study was to investigate the effect of systemic sclerosis (SSc) on quality of life and sexual function in female patients. Materials and methods: The study included 30 sexually active female patients with SSc and 30 healthy control subjects. For all participants in both the patient and control groups, the female sexual index and SF-36 forms were completed and a detailed medical and sexual history was taken. Results: The mean age was 45.03 ± 9.22 years in the SSc group and 44.6 ± 11.52 years in the control group (P = 0.87). The SF-36 scores in the patient group were significantly lower than those in the control group. Sexual dysfunction was found in 26/30 (86.6%) of the SSc patients and in 6/30 (20%) of the control group (P = 0.0001). Significant differences were determined between the groups with respect to sexual desire, arousal, lubrication, orgasm, sexual satisfaction, and pain. There was no significant relationship between the subgroups of SSc patients, duration of disease, lung involvement, and FSFI scores. Conclusion: Sexual dysfunction and lower health quality are common problems in female patients with systemic sclerosis.

Bipolar Energy Instruments in Laparoscopic Uterine Cancer Surgery: A Randomized Study.

OBJECTIVE: To compare the perioperative outcomes of patients with uterine cancer, who were operated using advanced or conventional bipolar instruments. MATERIALS AND METHODS: Patients with clinically early-stage endometrial cancer were randomized to advanced (LigaSure) or conventional (Robi forceps) bipolar groups. Surgeries were performed by laparoscopy. Hysterectomy and bilateral salpingo-oophorectomy with retroperitoneal lymphadenectomy were done in all cases. Primary endpoint of the study was to compare operation time for 2 groups. Other perioperative outcomes were also compared. ClinicalTrials.gov identifier number of the study was NCT02822820. RESULTS: Sixty-eight cases with endometrial cancer were randomized to 2 groups and each group included 34 subjects. Mean age and body mass index of all cases were 56.8 ± 10.4 years and 31.1 ± 5.3 kg/m2, respectively. Mean operation time was found significantly shorter in advanced bipolar group (134.2 ± 29.7 minutes versus 163.5 ± 27.7 minutes, P < .001). The other variables investigated such as intraoperative blood loss, duration of hospital stay, and postoperative pain scores did not show statistically significant difference between the groups. CONCLUSION: Operation time was shorter in advanced bipolar group, however, advanced and conventional bipolar energy instruments were comparable for other perioperative outcomes in laparoscopic endometrial cancer surgery.

Third trimester anemia extends the length of hospital stay after delivery.

OBJECTIVE: To assess the relationship between maternal third trimester anemia and hospital stay after delivery. MATERIALS AND METHODS: In this retrospective cross-sectional study, 695 women aged 18-42 years were included between January 2016 and June 2016. Obstetric outcomes and fetal outcomes were measured. Statistical analysis was performed using SPSS, version 19.0 (SPSS, Chicago, Illinois). RESULTS: The prevalence of anemia in this study was 15.2%. The study population was divided into three groups according to hemoglobin (Hb) levels. Group 1 consisted of patients with Hb <8.5 g/dL, group 2 Hb 8.5-11 g/dL, and group 3 Hb >11 g/dL. Higher levels of Hb were associated with shorter stay in hospital (p=0.028). In binary comparison, no significant difference was observed between groups 2 and 3, whereas it was statistically different from group 1. Fetal weight (p=0.562), neonatal intensive care unit admission (p=0.596), APGAR score 1st (p=0.674) and 5th minute (p=0.876), type of delivery (p=0.831), and gestational age (p=0.798) were not statistically different between the groups; however, hospitalization time was significantly different (p=0.028). CONCLUSION: Maternal anemia in the third trimester prolongs hospitalization time after delivery. Anemia effects pregnancy and the fetus in the postpartum period in addition to the prenatal period.

Delivery and postpartum management of a patient with Pompe disease: Case report and review of the literature.

Pompe disease is an autosomal-recessive disorder caused by acid alpha-glucosidase deficiency due to mutations in the GAA gene. There are two forms of the disease: infantile-onset Pompe disease and late-onset Pompe disease. The worldwide incidence of both forms of the disease is commonly reported to be 1 in 40,000. Adult patients are affected by limb-girdle muscular weakness and respiratory insufficiency. Enzyme replacement therapy with alglucosidase-alpha is available since 2006. There is little knowledge about pregnant woman with Pompe disease. These women should be considered as high-risk pregnant women. Here, we aim to present Cesarean delivery and postpartum management of a case with an interrupted enzyme replacement therapy during pregnancy.

Laparoscopic near-infrared fluorescent imaging as an alternative option for sentinel lymph node mapping in endometrial cancer: A prospective study.

BACKGROUND: To evaluate feasibility of sentinel lymph node (SLN) mapping by using near-infrared fluorescent imaging and indocyanine green (NIR/ICG) integrated laparoscopic system in clinically uterine-confined endometrial cancer. MATERIALS AND METHODS: Patients with clinically early-stage endometrial cancer were included in this prospective study. ICG was injected to the uterine cervix and NIR/ICG integrated laparoscopic system (Spies Full HD D-Light P ICG technology, Karl Storz, Tuttlingen, Germany) was used during the operations. SLN and/or suspicious lymph nodes were resected. Side specific lymphadenectomy was performed when mapping was unsuccessful. Systematic lymphadenectomy was completed following SLN algorithm steps. RESULTS: Seventy-one eligible patients were analyzed. The overall, unilateral and bilateral SLN detection rates were 95.7%, 18.3%, 77.4%, respectively. There were 8 (11.2%) patients with lymph node metastasis. One of them was isolated para-aortic node metastasis. Negative predictive value, sensitivity and false negative rate for detecting lymphatic spread were 98.4%, 87.5% and 1.5%, respectively. CONCLUSION: Sentinel lymph node mapping can easily be performed with high accuracy by using NIR/ICG integrated conventional laparoscopic system in endometrial cancer and almost all lymphatic spread can be detected.

Features of ovarian Brenner tumors: Experience of a single tertiary center.

OBJECTIVE: Brenner tumors are rare neoplasms of the ovary. The aim of this study was to investigate the clinical features of Brenner tumors. MATERIALS AND METHODS: The clinical features of 22 patients who were treated in Ankara University Faculty of Medicine Obstetrics and Gynecology Department between 2005 and 2015 were evaluated retrospectively from hospital medical records. RESULTS: The patients were aged 34 to 79 years at the time of diagnosis and the mean age was 55.1 years. Two (9.1%) patients were pre-menopausal, five (22.7%) were peri-menopausal, and 25 (68.2%) patients were postmenopausal. One patient was pregnant. Twenty of the neoplasms were benign, one was malignant, and one was both malignant and benign. There was no recurrence in the malignant cases. Six (27.2%) patients had mixed tumors consisting of Brenner tumor and another ovarian pathology. Specifically, the other component of these tumors was mucinous cystadenoma in four patients, endometriosis externa in one patient, and high-grade serous papillary cyst adenocarcinoma in one patient. CONCLUSION: Brenner tumors are usually incidental benign pathologic findings of surgical procedures in postmenopausal women. They can be found with other ovarian pathologies such as mucinous ovarian tumors and can coexist with other female genital tumors. Further studies are needed to completely understand the clinical features of Brenner tumors.

Triple Synchronous Malignancies in Genital Tract; Primary Endometrial, Ovarian and Fallopian Tube Carcinoma: A Case Report.

Synchronous malignancies, including three or more tumours, are extremely rare. Herein, we present a case of a woman with a concurrent simultaneous endometrial, ovarian and fallopian tubal carcinoma with different histopathological characteristics. A 55-year-old postmenopausal woman with a diagnosis of endometrial adenocarcinoma by pipelle biopsy, underwent surgical staging. Final pathology result was reported as synchronous stage IA grade 2 endometrioid adenocarcinoma of the uterus, stage IA grade 2 mucinous adenocarcinoma of the right ovary and in situ serous cystadenocarcinoma of the right fallopian tube. In the postoperative period, patient followed without adjuvant therapy. To our knowledge, this a very rare case report in the literature of sychronous triple gynaecologic cancers including fallopian tube cancer and with the longest disease free survival time with over 39 months due to better prognosis than metastatic or advanced primitive diseases.

True management of Obstructed Hemi-vagina and Ipsilateral Renal Anomaly syndrome.

Herlyn-Werner-Wunderlich syndrome is an unusual congenital anomaly of the female genitourinary system, which is described as uterine didelphys with Obstructed Hemi-vagina and Ipsilateral Renal Anomaly (OHIRA), also known as OHVIRA syndrome. Typical symptoms are pelvic pain, tenderness, pelvic mass due to blood collection in the obstructed hemi-vagina and uterus, and dysmenorrhea that usually begins shortly after menarche. Clinical suspicion is very important for diagnosis and correct management avoids both short- and long-term complications. Surgical removal of the vaginal septum is the main treatment method. Herein, we describe the evaluation and surgical management of a patient with OHVIRA syndrome who was diagnosed using magnetic resonance imaging and pelvic ultrasound.

Non-invasive prenatal testing for sex chromosome abnormalities: a source of confusion.

Cell-free fetal DNA has received significant attention for the purposes of prenatal genetic testing in the past decade. Fetal DNA testing is a new method and promising for many applications such as aneuploidy screening, prenatal diagnosis, prediction of preeclampsia and more. A 37-year-old primigravida, with a pregnancy conceived by intracytoplasmic sperm injection (ICSI), was offered non-invasive prenatal testing (NIPT) due to advanced maternal age. NIPT performed at 23 weeks' gestation reported a diagnosis of monosomy X. She was offered an amniocentesis, which revealed a euploid fetus with no sex chromosome abnormalities. Even with single nucleotide polymorphism-based NIPT, positive predictive value for detection of sex chromosome abnormalities is around 50%. Positive results of NIPT should be heeded with caution and an invasive diagnostic procedure should be performed, especially for rare chromosomal abnormalities and sex chromosome abnormalities where NIPT performs subpar compared to its performance for detection of trisomy 21.